0920-1354 Requirement for Airlines and Operators to Collect and Tr

Form
OMB Control No.: 0920-1354
Expiration date: 05/31/2022
Requirement for Airlines and Operators to Collect and Transmit Designated Information for
Passengers and Crew arriving into the United States; Requirement for Passengers to Provide
Designated Information
Below is information for airlines and operators for the collection of passenger information and
acknowledgment for this Order.
Digital and Paper Copy Instructions: The Form, OMB Control No., Expiration date, burden statement,
and Privacy Act Statement must be used when collecting passenger information digitally or by paper
copy. If applicable to the format used for the collection of information, place Form, OMB Control No.,
and Expiration date in the top right-hand corner of the collection form (as shown above). If using a
format in which that is not applicable, place the information before the collection of information. The
burden statement and Privacy Act Statement (see below) should be listed at the end of the information
collection. Below is a template that may be used to collect the required acknowledgement that they
understand the purpose and intent of the collection and that they must provide complete and accurate
information.
The U.S. Centers for Disease Control and Prevention (CDC) requires all passengers boarding an
international flight to the United States to provide their contact information within 72 hours before their
flight departs. The information may be used by U.S. public health officials to follow up with passengers
who may have been exposed to a contagious disease before or during travel. As a U.S. Government
requirement, passengers must provide complete and accurate contact information. Failure to do so may
subject the passenger or their authorized representative to criminal penalties under, among others, 42
U.S.C. 271 and 42 CFR 71.2, in conjunction with 18 U.S.C. 3559 and 3571. Willfully giving false or
misleading information to the government may result in criminal penalties under, among others, 18
U.S.C. 1001.
Each passenger is required to complete the following statement:
[ ] I understand that the U.S. Government requires me to provide my contact information and that failure
to provide complete and accurate information may result in criminal penalties.
[ ] I confirm the information I have provided is complete and accurate.
Verbal Instructions: Airline and operators’ employees may obtain the required contact information and
acknowledgement from passengers verbally. Airlines and operators must use the script below to obtain
the acknowledgement. Airlines and operators must conspicuously display the full burden statement and
Privacy Act Statement for passengers (e.g. on a laminated piece of paper or placard).
The U.S. Centers for Disease Control and Prevention (CDC) requires all passengers boarding an
international flight to the United States to provide their contact information within 72 hours before their
flight departs. The information may be used by U.S. public health officials to follow up with passengers
who may have been exposed to a contagious disease before or during travel. As a U.S. Government
requirement, passengers must provide complete and accurate contact information. Failure to do so may
result in criminal penalties. For more information about this collection of information, you may refer to
OMB Control Number 0920-1354 and may view the Privacy Act Statement to understand how the
government is protecting your information.
You can confirm your understanding of these requirements by stating “yes” to the following statements:

[ ] I understand that the U.S. Government requires me to provide my contact information and that failure
to provide complete and accurate information may result in criminal penalties.
[ ] I confirm the information I have provided is complete and accurate.
Burden Statement
Public reporting burden of this collection of information is estimated to average 2 minutes per response,
including the time for reviewing instructions, searching existing data sources, gathering and maintaining
the data needed, and completing and reviewing the collection of information. An agency may not
conduct or sponsor, and a person is not required to respond to a collection of information unless it
displays a currently valid OMB Control Number. Send comments regarding this burden estimate or any
other aspect of this collection of information, including suggestions for reducing this burden to
CDC/ATSDR Reports Clearance Officer, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN:
PRA 0920-1354
Privacy Act Statement
The United States Centers for Disease Control and Prevention (CDC) requires airlines and other aircraft
operators to collect this information pursuant to 42 C.F.R. §§ 71.4, 71.20, 71.31 and 71.32, as authorized
by 42 U.S.C. §§ 264 and 268. Providing this information is mandatory for all passengers arriving by
aircraft into the United States. Passengers are required to provide complete and accurate information,
and failure to do so may lead to other consequences, including criminal penalties. CDC will use this
information to help prevent the introduction, transmission, and spread of communicable diseases by
performing contact tracing investigations and notifying exposed individuals and public health
authorities; and for health education, treatment, prophylaxis, or other appropriate public health
interventions, including the implementation of travel restrictions. The Privacy Act of 1974, 5 U.S.C. §
552a, and the associated CDC System of Records No. 09-20-0171, Quarantine- and Traveler-Related
Activities, Including Records for Contact Tracing Investigation and Notification under 42 C.F.R. Parts 70
and 71. See 72 Fed. Reg. 70867 (Dec. 13, 2007), as amended by 76 Fed. Reg. 4485 (Jan. 25, 2011) and 83
Fed. Reg. 6591 (Feb. 14, 2018) [hyperlink] govern the collection and use of this information. CDC will
only disclose information from the system outside the CDC and the U.S. Department of Health and
Human Services as the Privacy Act permits, including in accordance with the routine uses published for
this system in the Federal Register, and as authorized by law. You may contact the system manager at
[email protected] or by mailing Policy Office, Division of Global Migration and Quarantine,
Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS H16-4, Atlanta, GA 30329, if you
have questions about CDC’s use of your data.